adhd symptoms and behaviors

Th ere is much current controversy about the diagnosis and management of
ADHD. Some reports indicate that this syndrome is being overdiagnosed
and that treatment is being too quickly provided to young people, while others
claim that ADHD is rather common and oft en missed and untreated or
undertreated (Belkin, 2004; Elia, Ambrosini, & Rapoport, 1999). Th e feelings
are further polarized by the fact that the main medicines for ADHD
treatment are stimulants, which are controlled substances and have some
potential for abuse. To further complicate matters, most people feel somewhat
more alert and focused aft er having taken small to moderate doses of
mild stimulants, and hence the frequent use of caff eine-containing drinks
such as coff ee, tea, or colas. Th erefore, a patient’s improvement on medication
does not necessarily support the diagnosis of ADHD. Further, there is
no defi nitive test for ADHD, which is a presumptive diagnosis that overlaps
with other problems; both anxiety and depression can cause concentration
problems. Additionally, in many cases the diagnosis is made by family practitioners,
pediatricians, or child psychiatrists based on very brief contact and
very superfi cial evaluation. Th e question of what happens to children with ADHD as they grow up is not resolved either (Steinhausen, Dreschler, Foldenyi,
Imhof, & Brandeis, 2003). Does it ease up with maturation? Do people
fi nd ways to adjust to it? Does it continue unchanged?
It helps to remember that by the time people have reached college age, most
cases of true ADHD have probably been identifi ed. Exceptions might be students
from other cultures or those who have grown up in unstable families,
been home-schooled, or attended schools in communities that have large
classes and little individual attention. It is also possible that a student who
has ADHD is so intelligent that the condition went undetected prior to the
rigorous academic pressures of college. On the whole, however, it is unusual
to fi nd new cases of true ADHD in college students.
As a result, when a student presents to a college mental health service asking
for evaluation and treatment for ADHD, some skepticism is warranted. If
available, thorough evaluation and testing at a specialized ADHD program
should be pursued. If not, a thorough psychiatric history and assessment
should be done with careful attention to the diff erential diagnosis of ADHD at
this age, including, but not limited to, anxiety disorders, depressive disorders,
adjustment problems, drug seeking, factitious disorder (intentional production
or feigning of symptoms), pure academic problems, or learning problems.
ADHD should be approached as a diagnosis of exclusion rather than a quickly
accepted likelihood.
If a student who has previously been evaluated and diagnosed with ADHD
presents for continuing treatment, medicines should certainly be maintained
for the short term. But whenever possible it is prudent to assess the reliability
of the diagnosis by communicating with previously treating clinicians and
reviewing reports. When the previous assessment appears to have been superfi
cial or of questionable reliability, an ADHD reassessment is warranted at a
suitable agency or program. (Th is is oft en quite costly.) It is useful to refer students
who have ADHD for academic support and tutoring and to the school’s
disability program for extra academic support and/or accommodations.